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CARDIOVASCULAR ANESTHESIA

Treatment of Hypoxemia During One-Lung Ventilation Using Intravenous Almitrine

From the Department of Anesthesiology, Hôpital Foch, Université Paris-Ouest, Suresnes, France

correspondence should be addressed to: M. Fischler, Service d’Anesthésie, Hôpital Foch, 40 rue Worth, 92151 Suresnes, France. Address email to fischler{at}hopital-foch.org

We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-eight patients were anesthetized with propofol, sufentanil, and atracurium; lung separation was achieved with a double-lumen tube. A transesophageal Doppler probe was inserted to evaluate cardiac index. If SpO₂ was equal to or decreased to <95% during OLV (inspired fraction of oxygen of 0.6), patients were included in the study and received a placebo or almit- rine (12 µg · kg^-1 · min^-1 for 10 min followed by 4 µg · kg^-1 · min^-1) infusion until SpO₂ reached 90% or decreased to <90% (exclusion from the study). Eighteen of the 28 patients were included and received either almitrine (n = 9) or a placebo (n = 9). Treatment was discontinued in 1 patient in the almitrine group and 6 in the placebo group (P < 0.05). Treatment was successful (SpO₂ remaining 95% during OLV) in 8 patients in the almitrine group and 1 in the placebo group (P < 0.01). Heart rate, arterial blood pressure, and cardiac index did not change throughout the study, but we could obtain an adequate aortic blood flow signal in only half of the patients. Almitrine could be used to treat hypoxemia during OLV.

IMPLICATIONS: IV almitrine improves oxygenation during one-lung ventilation without hemodynamic modification. Such treatment could be used when conventional ventilatory strategy fails to treat hypoxemia or cannot be used.

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